| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,748.04 | $9,774.00 | $14,552.94 | |
Aetna
| Facility | 50 | $36,657.76 | $36,657.76 | $42,846.05 |
Moda Health
| Facility | $1,160.61 | $4,636.55 | $6,630.27 | |
Providence
| Facility | $1,160.61 | $4,636.55 | $6,630.27 |